The high costs of "free" drug samples.

摘要: Pharmaceutical companies give physicians drug samples because it influences prescription writing and maximizes profits. Physicians in turn accept of mistaken beliefs psychologically impactful social pressures elicited by interactions with companies. Yet, physicians' acceptance risks bad clinical decision-making, endangers reputation, likely contributes to runaway health-care costs. To guard against these risks, should decline and, even more importantly, institutions physician organizations ban the multi-billion dollar practice sample distribution. Over 90% have some relationship pharmaceutical industry, from contacts representatives research collaborations beyond.1 Most physician–industry relationships are above-board hugely beneficial. The collaborative development novel biologics like imatinib infliximab prime examples.2, 3 Yet unseemly can harm patients as well undermine reputation. To protect health probity relationships, 2013 Physician Payments Sunshine Act requires intensified reporting about their industry including any value transfers >$100.4 Starting fall 2014, Centers for Medicaid Medicare Services posted such disclosures publicly, surely engendering a wider popular conversation which end. Physicians' receipt samples, however, explicitly exempted reporting, though invests >$5 billion yearly practice.5 Physician's is fact largely unregulated nationally, leaves individual choose stance on gifts. Each or must ask, “Are educational gifts manipulative bribes both?” Pharmaceutical provide effective business practice: prescribe received sample.6 This not surprising: extensive evidence shows strongly influence recipient's behavior.7 What surprising extent allow corrupt decision-making: use medications given if that choice irrational otherwise first choice.8, 9, 10 It difficult envision another circumstance would pass up best so willingly. Beyond saddling second-choice treatments, additional reasons worry imperil patient safety include lost opportunities pharmacists educate proper medication usage oversee storage post-expiry disposal medications.11 Physicians' only undermines quality care, also increases costs care expensive name-brand drugs less generic alternatives, thus prescribed less.12 no small problem: excessive major driver costs.13 Patient affordable things jeopardized physician's samples: endanger reputation. In one study,14 said they trust prescriptions preceded while study showed 31% disapprove samples.15 As increase costs, gamble why do welcome well-dressed who deliver them into our offices? Some believe, fallaciously, reduce poor patients. untrue: than wealthy receive samples,16 free often transition paid drive significant extra per month.12 Thus, paradoxically, may play altruism undermining poor. By contrast, company's support charitable compassionate release needed valuable contributions poor. Although many admit prescribing habit,17 view themselves invulnerable biasing samples.18, 19, 20 understandable generally well-intentioned believe bias, but ultimately disappointing be poorly convinced clear contrary. Still other enjoy easy availability families.21 unlikely access exerts strong financial pull physicians, sense obligation incurred cements pseudo-social bond between representatives. power this underestimated. Subtle connections agreeable-looking behavior,20, 22 I suspect, contribute reluctance face conflict interest inherent samples.23 Despite downsides entanglement over there hope will find better way. Twenty-three percent already,24 thoughtful account family group Oregon how disentangled company suggests doable relatively pain-free.25 Chimonas Kassirer11 wrote 2009 medical “profession begins slowly extract itself influential grip deal undue samples”. Their focus “the profession,” spot-on. Individual absolutely. historical disentangle effects real change occur until centralized physician-led movement samples. boards specialty advertize new freedom unwelcome bias Many academic already taken step25, 26 hopefully private follow. In time, enclosed each blister-pack go way advertisements smoking27: longstanding an almost-unfathomable tale we shake heads wonder aloud, “How could done something misguided long?”